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Are your babies on these drugs?
Are Your Babies On These Drugs ? When in doubt, ask your Pharmacist. Most drugs present in the mother's blood will be present in her milk. Only a few are in large enough amounts to affect the baby. Milk is a mild acid. Drugs that are basic (alkaline) may concentrate in the milk. There is a lot of fat in milk, especially in colostrum. Therefore a substance which dissolves in fat can pass into milk, for example, the insecticide DDT. Generally the risk to a breastfed baby by a drug that the mother is taking is reduced when the mother takes the drug just after feeding the baby. Another point about drugs and milk is that cow's milk may contain drugs and chemicals. This may cause problems for people who drink the milk. Penicillin in milk has caused hypersensitivity and pesticides can be toxic. It is wise not to add medicines to the milk in a feeding bottle. The drug may interact with the milk, or the dose may be reduced if not all of the contents are consumed. Below, there is a brief list of drugs which are commonly prescribed. For information on drugs which are not listed, consult your local Drug and Poisons Information Centre. The pharmacy departments of major hospitals all supply a similar service.
Anti-infectives Penicillin: may cause allergy Nalidixic Acid: haemolytic anaemia in susceptible infants (G6PD deficient) Nitrofurantoin: as for Nalidixic Acid Metronidazole: not contraindicated for short (under 7 days) courses in normal (600mg) oral doses, but may give bitter taste to milk. Caution advised when giving higher doses as secreted in significant amounts. May cause vomiting, diarrhoea and reduced appetite. May be given as a single dose with b r e a s t f e e d i n g discontinued for 24 hours.
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Co-trimoxazole: slight risk from sulpha content; see Sulphonamides Sulphonamides: Very occasionally some may cause diat:rhoea, rash jaundice, kernicterus Tinidazole: significant quantities in milk, little experience in the very young, mutagenic/tnmorigenic potential so contraindicated Pyrantel: No data available on levels in breastmilk, however this drug is very poorly absorbed from the gut, so only a tiny amount would be found in milk. Pyrantel may in any case be safely given to infants
Painkillers Aspirin: Low dose occasional use may be permitted, but the association between Aspirin and Reye's Syndrome in children under 12 years means that the nursing mother should not use this drug when suffering from a viral illness. Large doses may cause bleeding in the baby. Rashes, poor growth and acidosis can also occur. Paraeetamol: a small amount is secreted into breastmilk, but no harmful effects in the infant have been noted when only conventional doses have been taken. Indomethacin: milk to plasma ratio is 1:1, and one case of convulsions has been reported in a neonate, therefore a safer drug should be chosen Opiates & Narcotics: the amounts present in milk are usually too small to affect the baby after single doses, but a cumulative effect is possible. Oral contraceptives Oestrogen in pills such as Microgynon, Nordette and Triquilar can decrease milk supply. The longterm effects on the baby are unknown. Progesterone only pills such as Microval and Microlut are available for brcasffeeding mothers.
Social drugs
taken in small amounts there shouldbe no great problem. Alcohol: occasional use is OK Alcohol may in theory inhibit oxytocin release and therefore milk secretion, cause drowsiness, poor growth and weakness and chronic use may produce a pseudoCushings' syndrome Caffeine: approx. 1% of dose is excreted in breast milk Frequent or high doses may lead to accumulation (half life in infants is up to 80 hours) Excessive doses cause wakefulness, hyperactivity and poor sleeping pattern Nicotine: Excess use of Nicotine chewing gum can cause shock, vomiting, diarrhoea, tachycardia, restlessness and decreased milk production. Decreased milk production also occurs in heavy smokers (over 20 per day). Marijuana: Low levels are excreted in milk, not much is known of the effects on infants. Helgi Stone, Drug and Poisons Information Officer Pharmacy Department, Royal Darwin Hospital 6.10.87 REFERENCES 1. Drugs and Breast Feeding, Ron Batagol, Drug Information Service, Royal Women's Hospital, Carlton, Victoria, published by CSL 2. A Guide to Drugs and Lactation, Current Therapeutics, Adis Press 3. Drags in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, Briggs GG et al, Williams & Wilkins, Baltimore 1983 4. Drugs in Breast Milk, Wilson JT, Adis Press, 1981 5. Glen-Bott AM, Aspirin and Reye's Syndrome: A Reappraisal, Current Therapeutics, September 1 9 8 7 : 3 3 4 2 6. PP Guide 1987.
All these drugs pass into the milk, but
ACMI Journal, JUNE 1988
Anti-infectives Penicillin: may cause allergy Nalidixic Acid: haemolytic anaemia in susceptible infants (G6PD deficient) Nitrofurantoin: as for Nalidixic Acid Metronidazole: not contraindicated for short (under 7 days) courses in normal (600mg) oral doses, but may give bitter taste to milk. Caution advised when giving higher doses as secreted in significant amounts. May cause vomiting, diarrhoea and reduced appetite. May be given as a single dose with b r e a s t f e e d i n g discontinued for 24 hours.
Page 12
Co-trimoxazole: slight risk from sulpha content; see Sulphonamides Sulphonamides: Very occasionally some may cause diat:rhoea, rash jaundice, kernicterus Tinidazole: significant quantities in milk, little experience in the very young, mutagenic/tnmorigenic potential so contraindicated Pyrantel: No data available on levels in breastmilk, however this drug is very poorly absorbed from the gut, so only a tiny amount would be found in milk. Pyrantel may in any case be safely given to infants
Painkillers Aspirin: Low dose occasional use may be permitted, but the association between Aspirin and Reye's Syndrome in children under 12 years means that the nursing mother should not use this drug when suffering from a viral illness. Large doses may cause bleeding in the baby. Rashes, poor growth and acidosis can also occur. Paraeetamol: a small amount is secreted into breastmilk, but no harmful effects in the infant have been noted when only conventional doses have been taken. Indomethacin: milk to plasma ratio is 1:1, and one case of convulsions has been reported in a neonate, therefore a safer drug should be chosen Opiates & Narcotics: the amounts present in milk are usually too small to affect the baby after single doses, but a cumulative effect is possible. Oral contraceptives Oestrogen in pills such as Microgynon, Nordette and Triquilar can decrease milk supply. The longterm effects on the baby are unknown. Progesterone only pills such as Microval and Microlut are available for brcasffeeding mothers.
Social drugs
taken in small amounts there shouldbe no great problem. Alcohol: occasional use is OK Alcohol may in theory inhibit oxytocin release and therefore milk secretion, cause drowsiness, poor growth and weakness and chronic use may produce a pseudoCushings' syndrome Caffeine: approx. 1% of dose is excreted in breast milk Frequent or high doses may lead to accumulation (half life in infants is up to 80 hours) Excessive doses cause wakefulness, hyperactivity and poor sleeping pattern Nicotine: Excess use of Nicotine chewing gum can cause shock, vomiting, diarrhoea, tachycardia, restlessness and decreased milk production. Decreased milk production also occurs in heavy smokers (over 20 per day). Marijuana: Low levels are excreted in milk, not much is known of the effects on infants. Helgi Stone, Drug and Poisons Information Officer Pharmacy Department, Royal Darwin Hospital 6.10.87 REFERENCES 1. Drugs and Breast Feeding, Ron Batagol, Drug Information Service, Royal Women's Hospital, Carlton, Victoria, published by CSL 2. A Guide to Drugs and Lactation, Current Therapeutics, Adis Press 3. Drags in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, Briggs GG et al, Williams & Wilkins, Baltimore 1983 4. Drugs in Breast Milk, Wilson JT, Adis Press, 1981 5. Glen-Bott AM, Aspirin and Reye's Syndrome: A Reappraisal, Current Therapeutics, September 1 9 8 7 : 3 3 4 2 6. PP Guide 1987.
All these drugs pass into the milk, but
ACMI Journal, JUNE 1988